Mandibular fractures are quite common facial injuries, but aetiology varies with country and age. Common treatment options are open reduction and internal fixation via an intra oral or extra oral incision. Nerve injury or dysfunction is often seen preoperatively and may also be a complication of surgery. One of the more common nerve injuries is postoperative hypoesthesia of the ipsilateral mental nerve following open reduction and internal fixation (ORIF). Injury to the inferior alveolar nerve can cause a severe reduction in the quality of life and also may cause chronic pain states. Apart from malocclusion this can be one of the more devastating effects of a mandibular fracture. It is sometimes difficult to predict, postoperatively the patients that will have persistent postoperative nerve function compromise.

This is a large longish term study, of the recovery of the function of the inferior alveolar nerve from one centre in Zurich. It is a retrospective analysis of 340 patients included in the study from one University teaching hospital. It is a good paper that confirms a number of widely held thoughts. It confirms complete recovery in over 70% of patients, and discusses factors that affect recovery. Clearly fractures within the angle region have a higher degree of hypoesthesia and the authors suggest caution during the ORIF. Younger patients as expected have better outcomes too. This is a well written paper with good methodology and worth reading if a surgeons practice includes treating patients with mandibular fractures. 

Inferior alveolar nerve function after open reduction and internal fixation of mandibular fractures.
Schenkel JS, Jacobsen C, Rostetter C, et al.
Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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